Non-O157 Shiga Toxin–Producing Escherichia Coli (STEC) In Africa: A One Health Systematic Review And Meta-Analysis Of Prevalence, Antimicrobial Resistance, And Clinical Outcomes

Abstract

Non-O157 Shiga Toxin–Producing Escherichia coli (non-O157 STEC) pathogens cause considerable debilities and were reviewed for its prevalence, antimicrobial Resistance, and clinical outcomes in Africa from a One Health perspective. Following the PRISMA guidelines, studies reporting non-O157 STEC in human, animal, environmental and food samples from African countries were retrieved from African Journals Online, Scopus, Google Scholar, Web of Science, and PubMed. Retrieved data were analyzed using random-effects model by the DerSimonian–Laird method and assessment of risk-of-bias for individual studies, with Egger’s test. Of 22 included studies, most were conducted in Northern Africa (59%, n = 13). The most frequently reported STEC serogroups were O26 (26.60%), O45 (8.21%), O111 (7.6%), O121 (3.34%), O145 (4.10%), O78 and O91 (4.10%). Virulence genes including Stx1 (24.9%), stx2 (19.7%), and eae were commonly detected in isolates from human samples than in isolates from other sources. Pooled prevalence of non-O157 STEC in African countries was 20.7% (95% CI: 11.1–30.2, I2 = 97.4%, p = 0.0001) with combined human-animal sources pooled prevalence of 27.3% (95% CI: 9.2–45.3; I2 = 98.6%; p = 0.0001). More than 10% pooled resistance to commonly used antibiotics and high proportion of strains harboring blaTEM, blaVIM, blaNDM, blaCTX, blaOXA encoding ESBLs, tet variants for tetracycline, sul1 and sul2 encoding resistance for sulphamethoxaole, and qnrS (for fluoroquinolone resistance) were recorded. Non-O157 STEC associated infections showing clinical presentations characterized by diarrhea, gastroenteritis, and UTI which were mostly observed in children < 5 years. The prevalence rates and antimicrobial resistance pattern of non-O157 STEC serogroups is a growing concern to African populations and clinical outcomes. There is a need for public enlightenment on prevention of non-O157 STEC with One Health approach.